Eligibility screening
Every claim is screened for NSA coverage, timely filing, and qualifying payment amount (QPA) threshold — all present, or the submission does not release.
The most rigorous NSA IDR recovery service a mid-market provider can use.
ClaimArbiter assembles a documentation-complete IDR submission package — eligibility screening, batching, QPA analysis, offer rationale, and attestations — checked against the letter of 45 C.F.R. Part 149 before a compliance specialist releases it.
Every subsection of 45 C.F.R. § 149.510Eligibility screening, deadline tracking, batching rulesQPA analysis and offer rationale draftingCompliance specialist release on every submission5-business-day SLA
Why submissions fail
A single missing element can void the entire dispute.
A provider's IDR submission is only as strong as the documentation behind it. Miss an eligibility requirement, skip a deadline, mis-batch claims, or fail to write a persuasive offer rationale — and the dispute can be ruled ineligible, dismissed, or result in a low award.
Most mid-market providers run this by hand, from memory, once or twice a year. The regulations have not been read end-to-end since the last time it mattered. That is exactly where completeness gaps hide.
ClaimArbiter exists to close that gap with a single, exhaustive standard applied identically to every dispute.
1 in 5
submissions ruled ineligible — pure waste
The benchmark
Measured against the letter of the regulation — subsection by subsection.
We do not summarize the law and hope. Every submission is scored against a versioned rule pack tied to the exact text of 45 C.F.R. Part 149. These are the provisions each submission is held to.
Batching rules
Claims are batched only when they involve the same item/service, same payer, same plan, and same dispute period — verified deterministically, never estimated.
QPA analysis
The QPA is extracted from the remittance and compared to the provider's billed amount; the offer rationale must demonstrate why the QPA is not appropriate.
Offer rationale
A written justification citing the statutory factors (patient acuity, training, market share, etc.) and supporting evidence — drafted from validated data, no invented facts.
Attestation and signature
A compliance specialist reviews and signs the attestation; high-dollar or complex disputes route to attorney review first.
Deadline compliance
The 4-business-day initiation window and 30-business-day response window are tracked and enforced; any failure blocks release.
How a submission is built
Intake to compliance specialist release, with deterministic gates the AI cannot overrule.
AI extracts and drafts. Deterministic rules — running as code, outside the model — decide what is complete. A human compliance specialist signs every release. That order is never reversed.
01
Eligibility Scan
Upload a claims feed and remittances. We return a free eligibility read: which claims are NSA-covered, which deadlines apply, and which are missing documentation.
02
Data extraction & QPA analysis
As your authorized agent, we extract QPA, billed amounts, and service codes from remittances and build the dispute matrix, corroborated across sources.
03
Grounded drafting
The offer rationale is drafted from validated data and the 45 C.F.R. rule pack into field-locked templates — no legal opinions, no invented facts.
04
Deterministic completeness gates
Eligibility is verified; batching rules are enforced; deadlines are checked; QPA analysis is reconciled; attestation is reviewed. Any failure blocks release.
05
Compliance specialist release
A compliance specialist reviews the exception queue and signs the release. High-dollar or complex disputes route to attorney review first.
06
Submission & tracking
You receive the submission package: dispute forms, offer rationale, evidence log, attestation, and tracking calendar — ready for the provider to submit under its own name.
The bar we hold
Rigor you can measure.
100%
Compliance specialist-released
No submission ships without a human signature.
5 days
Standard SLA
From complete intake to released submission.
<1%
Ineligibility target
Tracked against a gold-standard submission library.
3
Statutory factors analyzed
Patient acuity, training, market share — every applicable dispute.
Why ClaimArbiter
Built to be the most thorough option a provider has.
Documentation-complete, by design
The deliverable is completeness itself — every regulatory element and analysis accounted for or explicitly exception-coded. Nothing is left implicit.
Deterministic, not vibes
The gates that decide completeness are code, not a model's opinion. A drafting error cannot slip past a regulatory requirement.
In its lane, on purpose
We prepare documentation and run analyses as your clerical agent. We never give legal advice, contact the payer, or submit the dispute on your behalf.
Engagement
Flat fee per submission, plus disclosed pass-through fees. No contingency, ever.
Simple, predictable, and aligned with a documentation standard — not a cut of any recovery.
- A free Eligibility Scan before you commit — see exactly which claims are eligible and what is missing.
- One flat fee per released IDR submission package; disclosed pass-through IDR entity fees.
- Optional fixed-fee attorney review for high-dollar or complex disputes.
- Optional Batch Optimization Add-on for multi-claim batching strategy.
FAQ
Questions, answered precisely.
Is ClaimArbiter a law firm?
No. ClaimArbiter, a service of Blueprint, provides documentation-completeness services. It is not a law firm, does not provide legal advice, and does not represent you in any legal matter. Attorney review is available and recommended for high-dollar or complex disputes.
Do you contact the payer or submit the dispute?
Never. ClaimArbiter is not a party to the dispute and does not contact payers or submit disputes on your behalf. The provider remains the disputing party and is responsible for all submissions.
What makes a submission 'complete'?
Completeness is defined by the regulation: eligibility screening, batching rules, QPA analysis, offer rationale, attestation, and deadline compliance — all verified by deterministic gates before release.
How fast is it?
The standard SLA is five business days from complete intake to a compliance specialist-released submission. The free Eligibility Scan is returned much sooner and tells you exactly which claims are eligible.
How are you priced?
A flat fee per released submission package, plus disclosed pass-through IDR entity fees. No contingency and no percentage of any recovered amount.
See which claims are eligible before you waste a submission.
Start with a free Eligibility Scan. Send your claims feed and remittances and we'll return an eligibility read against every subsection of 45 C.F.R. Part 149.
Documentation-completeness service · not legal advice · the provider submits every dispute.